Wednesday, November 12, 2014
A TRIAL of LABOR
"With the prevailing attitudes in this culture that birth is unsafe, that women aren't physiologically or psychologically designed to have babies anyway, and that the total management of labor and delivery is essential, it is no wonder that women find their instincts blocked, their hormones confused, their confidence disintegrating, their dignity stripped. We are part of one big obstetrical disgrace. One mammoth maternity mess." --Nancy Wainer Cohen, "Open Season: Survival Guide for Natural Childbirth and VBAC in the 90s"
[This post is not about patents and human milk components or infant formula. This post is about witnessing a birth in a hospital in the USA. It's about my need to document how inhumane birth has become under the driving force of technology and supposed safety concerns. It comes from my heart and soul as a mother and grandmother. It's about witnessing the insanity of confining a active, healthy woman to a bed to give birth. And about medical staff spending more time and attention with their technological gadgets than the laboring mother. It is no wonder that the c-section rate in the USA has skyrocketed to a ridiculous level. Website showing c-section rates in USA.
c-section rate in Florida by hospital
Last weekend was cold and blustery for Florida. Unusual weather for this time of year in a southern state known for its warmth and sunshine. The weather wasn't the only change arriving into my life. My daughter's husband called to tell me that my daughter was in the early stages of labor. Since my daughter had asked me to be with her during labor and delivery, I felt a wave of excitement and apprehension. All my babies had been born at home with midwives from a free-standing birth center. After the home birth of my first baby, I volunteered with the birth center. As a volunteer I answered the phone,filed papers and did pregnancy tests. I attended some home births as the babysitter for the birthing mother's children. I was not a midwife nor did I have an interest in becoming a midwife. I volunteered out of gratitude to the midwives for the services they offered to me and other women in the community. They helped educate me and many other women in our community about birth and breastfeeding. Office visits were often an hour long with the midwives giving of their time and attention to a pregnant woman's concerns. The individual attention given by midwives is in stark contrast to what the medical profession offers pregnant and laboring mothers. The Birth Center eventually closed down in 1985, largely due to the inability to get physician backup. I never witnessed a birth in a hospital. Although I had mothers tell me their hospital birth stories and was often appalled by what women think is normal procedures in birth. I wasn't sure what to expect with my daughter's labor nor was I very up-to-date on what the birthing situation was like nowadays. I pictured in my mind that I would hold her hand and give her the support that all women need during birth. I have never forgotten the midwife who held my hand during my first birth. She helped me weather the storm of contractions that birthed my baby. That baby, now an adult, was now having her own baby.
My daughter had had a c-section with her first baby because the baby was breech despite several attempts to turn the baby head down by external version. With this second baby she wanted to have a VBAC (Vaginal Birth After Cesarean Section). Only certain hospitals do VBACs. Women who want a VBAC are considered by the medical profession to be high risk without consideration to individual health and circumstances of previous c-section. Her local hospital did not do VBACs despite the fact that they did her first cesarean. So she had to go to a major teaching hospital some 40 minutes away.
My daughter handled early labor beautifully. She walked, she rested, she ate lightly, drank fluids, and was very, very positive. Her lower back was bothering her, so she went to her chiropractor and had an adjustment. The back pain disappeared making her more comfortable. Her contractions eased up and were intermittent. She was able to sleep the night. The next morning the contractions started up again, stronger but she was rested and feeling confident. By early afternoon, she became concerned because she hadn't felt the baby kick but once or twice some hours earlier. She called the hospital and they told her to come in to be checked. So we left for the hospital. At the hospital they hooked her up to the fetal monitor. And there it was the thumping beat of the baby's heart. Relief, the baby is okay. They then did an internal check and she was 3-4 cm dilated and 70% effaced. She decided to be admitted to the hospital. Since this was a teaching hospital, I overheard one of the nurses stating to what I gathered was a student nurse that since my daughter wanted a VBAC the hospital offered a trial of labor. The way in which it was said gave me the shivers. A TRIAL of LABOR, the words kept running around in my head. A trial?? Like a criminal trial, where it is decided whether you are guilty or innocent? A trial? Like an athletic event, where there are winners or losers? The Merriam Webster dictionary defines "trial" in several ways:
"A formal meeting in a court in which evidence about crimes, disagreements, etc. is presented to a judge and often a jury so that decisions can be made according to law."
or, "A test of the quality, value or usefulness of something."
or, "A test of someone's ability to do something that is used to see if he or she could join a team, perform in a play, etc."
These words that the medical community use have meaning and a psychological impact on mothers and their families. This was a test of labor to see if they would let the mother birth vaginally. How many pass the test to birth vaginally? How many at this particular hospital passed their tests? What were their tests? This whole idea of a trial/test in birthing is a very foreign concept in my mind. Particularly if you believe like I do that the deck is stacked against the laboring mother.
While my home-birth mind ran through these words, trial of labor, over and over again, a nurse came in to put in an IV into my daughter's arm. The nurse botched the insertion and then played with it to get it to work. I had seen botched IVs done to both my parents when they were hospitalized. And seen the consequences of botched IVs--swollen hands, arms, bruising, numbness. If this was a Hollywood movie, then this botched IV would have been the ominous sign of worse things to come. Almost all women are given IVs in hospital births. This never use to be a standard of practice for birthing moms. It limits mobility as well as having other risks.
Part of the admittance to labor and delivery was the medical staff asking my daughter about whether she wanted an epidural, pitocin, etc. My daughter said no to pain meds, pitocin, and the epidural. But she added that her decision was flexible. She was willing to reconsider based on how her labor progressed. Her refusal of the epidural seemed to surprise the staff or was it surprise? I was overwhelmed by this feeling that in this trial of labor, my daughter did not give the right answers to these people.
It seems the fetal monitor straps that they had put on her belly to hear the baby's heart beat and monitor contractions were to be kept on throughout labor. They did offer what they called a remote fetal monitor, so that she could walk during labor rather than being confined to the bed. She gladly accepted the remote because walking or standing during a contraction felt much better than being in bed.
What we noticed right from the beginning was that the straps to the fetal monitor seemed to loosen over time and that effected the machine's ability to record a heartbeat and/or contractions. This technical problem of a man-made machine caused the nurses to constantly show up in the room and peer at the monitor and its paper trail spewing onto the floor. Then the nurse would rearrange the straps of the fetal monitor on my daughter's belly. The monitor was showing decelerations of the baby's heartbeat. Were the decelerations (lowered heart beat showing that the baby is in stress)really happening or was this just a problem caused by a strap system that loosens when a mother walks or moves in bed? Strangely enough, even though the nurses were fiddling with the straps every time they walked into the room, they always presumed that the reading of decelerations was correct. We realized after a time that the paper trail made by this machine was the medical profession's only reality. My daughter at one point angrily stated that she hated the machine. Watching the straps slipping and sliding around her belly, I found myself hard pressed to believe in the accuracy of the machine. The cold and cruel reality is that this is the evidence that the medical staff used to create the next set of interventions.
We were pretty much left alone through the rest of the day and throughout the night, other than the staff peering at the machine and readjusting the straps to the monitor. In the morning of the next day, a doc suggested pitocin to get things going, since she was "still" 3 cm dilated. That recommendation meant that my daughter would be confined to bed and taken off the remote fetal monitor. As the remote got bagged up, the nurse dropped the machine on the floor. This was the hospital's relatively new remote machine. I wondered whether something got damaged by the fall? Was this the first time that this machine had fallen to the floor? From now on my daughter would be directly hooked to the machine sitting by her bed that spewed the paper trail of zig-zag graphs recording heartbeats and contractions. And she would be getting pitocin without pain relief. Something I would never be brave enough to do because I had heard so many stories about pitocin and its ability to create painful and multiple contractions.
My daughter's labor seemed little changed by the introduction of pitocin and she handled the contractions quite well. At some point they said my daughter needed to be on oxygen for the baby's sake. So they strapped on a mask that was tethered to a wall outlet of oxygen. But about an hour later they stopped the pitocin because they said the baby was not appearing to cope well with the pitocin. As time went on, leading into the afternoon of the third day that my daughter had been in labor, I could see that she was tired from lack of sleep and the continued contractions. And at some point they decided to restart the pitocin and her contractions became more fierce. Being stuck in a bed while having contractions is a very difficult thing to handle. She had not been allowed food or water all this time, although ice chips were allowed. Suddenly, a new doctor and more nurses came into the room. The doctor stated that what was needed is an internal monitor of her contractions as well as an internal fetal monitor. He stated that this would increase her contractions but would speed up the delivery. He never presented the risks, the drawbacks to this procedure. He wasn't really asking her whether she wanted to do it but rather telling her that this was what needed to be done. She agreed to it. And my heart took a nosedive. Breaking her water would make the contractions even more difficult to withstand and an internal fetal monitor is so invasive (they screw the wires into the baby's scalp--I had seen the result of this on some of the breastfeeding babies I had worked with). The medical staff flattened out the bed so the doc could break the amniotic sac that protects the baby from the contractions and infections. She was still 3 cm dilated when they did this procedure and had had no pain medications. The water broke and there seemed to be a ton of water pouring out onto the bed. Then the doc tried to put the fetal monitor into the baby's head. It was at this point that my daughter started to scream and cry. The doc said he was sorry but he couldn't get the internal fetal monitor in place. He left the room. He never made another attempt at placing the internal fetal monitor. I am not sure why he gave up but I was thankful that he stopped. Did he put that screw into my daughter's cervix rather than the baby? What happened? Meanwhile the contractions became more and more vicious, one on top of the other; and my daughter was losing her ability to breathe through the contractions. At this point in time, she began to complain about her arm, where the IV was located. It had become painful to her and I noticed that the hand and the arm were swollen until the hospital bands looked like they were cutting off circulation. She yelled at the nurse to change the IV to the other arm because she was losing feeling in her arm. The nurse proceeded to try to insert another IV in the other arm. The nurse couldn't do it. And in the mean time the contractions keep rolling onwards, doubling and tripling. They asked my daughter if she wanted an epidural for the pain and at first she said yes. But as each painful contraction came one on top of the other and with them trying to change the IV to the other arm, my daughter decided that she couldn't take it anymore and told them she wanted a c-section. They asked her if she was sure about it cause they could do an epidural. She could continue on with this trial of labor. Of course they wouldn't know how much longer she would be in labor. After 3 days in labor, confinement to a uncomfortable bed, little sleep, no food or water: the decision was made.
As they wheeled my daughter out of the room for surgery, I turned to one of the nurses and asked who was the surgeon who would be doing the c-section. The nurse said his name and he was the doctor who had just broken her water and botched the internal fetal monitor. I went numb inside. So the same doctor who does the invasive procedures that lead to this c-section is also the doctor who does the c-section? Isn't that a conflict of interest? I felt fear grip me. He obviously screwed up the internal fetal monitor. Would he screw up the surgery?
I felt the tears in my eyes and in my heart. How do woman give birth like this? I who had home births. I had listened and was nearby at other home births and never seen these kinds of invasive procedures or the level of pain generated from these procedures. I feel so naive and old. What I witnessed in my daughter's birth I cannot easily forget. Do women have any civil liberties while giving birth? Do they even have the freedom to reject any procedure? Are they told clearly the risks of each procedure? Is all the machinery and gadgetry a test for how much pain a women can withstand? And can any women withstand the amount of pain that the American hospital way of birth inflicts? I know I couldn't do it. I'd be begging for a c-section. Not allowing a woman to walk, eat or drink during labor is torture. The medical profession is fixed on the belief that their machines and interventions save babies. The profession seems to have lost the ability to care for the laboring mother. They care more for the machine, the paper strips of supposed proof of the ability to birth. They trust the machine over the mother and consequently destroy rather than empower women to give birth. (recent Florida news report on woman being forced to have a c-section)
If this system of birth, this trial of labor created less morbidity and mortality in women and babies, I would believe that maybe all these inhumane, painful, and torturous procedures might be worth the better outcomes. But the reality is that in 2010 the US ranked 50th in the world for maternal mortality.
"An estimated 11,300 newborn babies die each year in the United States on the day they are born. This is 50% more first-day deaths than all the other industrialized countries combined."
I have had young women say to me that they thought I had a lot of courage to have had my babies at home. They don't know how I withstood the pain. And all I could say is that young women who go into hospitals to have their babies have much more courage than I. When it comes to pain, I am a wimp. I am too afraid of the pain, to have a tattoo In a dentist chair, I want as much pain relief as possible. There is something seriously wrong with birthing in the USA. Why do we accept that these Trials of Labor (because every woman is on trial) are normal? It appears to me to be so abnormal that for days after my daughter's labor and c-section I had tears in my eyes. I am weeping for my daughters. I am weeping for a whole generation of young women who have no real chance at a normal birth. The deck is stacked against them because the medical community has determined that birth has to be tested and controlled through technology.
Copyright 2014 Valerie W. McClain
My daughter and her baby are home and doing well. I am grateful they survived all the interventions. I am not grateful about her treatment, her trial of labor in the hospital. I think many of the interventions were unnecessary and subjected her to pain that could have been prevented.
I also found myself reflecting on the midwives that helped me during my labors some 30 years ago. They will always be held in my heart with the highest esteem for the kind of care they gave me and my babies. They gave so much to all the mothers that they had in their care.
I think that medical people who are involved with laboring mothers should have to spend a day in a hospital bed having simulated contractions. They would be tethered to a machine. Humans would come and go to check the miracle machine but pay no attention to them. They would not be allowed to get up and walk around to relieve their pain, no food or drink. I would also like these people to witness a number of home births. Without the knowledge of normal birth, how can you give quality care to laboring women?